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Neuropsych Conference. March 16, 2012 Block 10A. General Data. R. DR 4 4/M Married Right-handed Unemployed From Muntinlupa CC : behavioral changes. Profile. History of trauma, s/p craniotomy (2008) Diagnosed with seizure disorder (2009) Phenobarbital ½ gr. BID, poor compliance

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neuropsych conference

Neuropsych Conference

March 16, 2012

Block 10A

general data
General Data

R. DR

44/M

Married

Right-handed

Unemployed

From Muntinlupa

CC: behavioral changes

profile
Profile
    • History of trauma, s/p craniotomy (2008)
  • Diagnosed with seizure disorder (2009)
    • Phenobarbital ½ gr. BID, poor compliance
    • Last seizure: Jan 23, 2012
  • PTB, adequately treated
  • Alcoholic beverage drinker: 20 years
history of present illness
History of Present Illness
  • 4 mos. PTA
    • (+) behavioral changes, insomnia, anorexia
    • (+) auditory hallucinations
    • episodes of intoxication  violent behavior wife and children left
history of present illness1
History of Present Illness
  • 4 mos. PTA
    • Seizure episode
      • Stiffening of extremities
      • Upward rolling of eyes
      • Drooling
      • Loss of consciousness
      • Post-ictal confusion
    • Brought to PGH  managed as a case of seizure disorder
history of present illness2
History of Present Illness

Interim:

  • Poor compliance (Pb BID)  recurrence of seizure episodes (last Jan 23, 2012)
  • Advised to consult at Psych OPD  lost to follow up
  • Persistence of violent behavior, auditory hallucinations and paranoia  consult  admission
review of systems
Review of Systems

(-) Weight changes

(-) Fever

(-) Headache

(+) BOV

(-) Nausea, vomiting

(-) Cough/colds

(-) Chest pain

(-) DOB

(-) Abdominal pain

(-) Changes in bowel movement

(-) Dysuria/hematuria

(-) Tremors

(-) Palpitation

past medical history
Past Medical History

As stated

No DM, HPN, asthma, allergies, kidney/liver disease

No other hospitalization/surgery

family medical history
Family Medical History

(+) Hypertension - mother

(+) Heart disease – mother

(-) Diabetes / stroke / epilepsy / asthma / allergy

(-) Psych illness

(+) Substance abuse – sibling

(+) Kidney disease -sibling

personal social history
Personal/Social History
  • Currently unemployed
  • Used to live with wife and 3 children (ages 9, 8 and 7)
  • Alcoholic beverage drinker – 20 yrs
  • (+) smoking – since elementary, consuming 1-2 packs per day
anamnesis
Anamnesis

Informant: patient

Born full term via SVD to a then 32y/o G7P6 (6006) mother, no fetomaternal complications

Childhood: shy but had close friends; average in school

slide12

Adulthood:

    • Finished 2nd year of Criminology due to illicit drug use and alcohol drinking
    • (+) MAP use, other drugs  sometimes hurts himself
    • Held several jobs (bartender, waiter, factory worker)
    • Felt that his coworkers were gossiping about him  (+) violence against a coworker
    • Once a full time preacher of El Shaddai
    • Had 2 intimate relationships: married in 2011, has 3 children
slide13

2009

    • Vehicular crash (jeepneyvs pedestrian); intoxicated
    • s/p craniotomy
    • Post-op: worse alcohol drinking, episodes of forgetfulness
physical exam
Physical Exam

Awake, alert,follows commands, NICRD

BP 120/80

PR 88

RR 20

T 36.8

systemic examination
Systemic Examination
  • Head and Neck
    • Anictericsclerae, pink conjunctivae, (-) masses/discharge, (-) CLAD, (-) anterior neck mass, (-) dentition
    • (+) skull depression, right temporal area
  • Chest
    • Equal chest expansion, clear breath sounds
  • Heart
    • Adynamicprecordium, distinct heart sounds S1 and S2, normal rate regular rhythm, (-) murmurs
slide16

Abdomen

    • Flabby, normoactive bowel sounds, soft, nontender
    • (+) several hypertrophic linear scars, midline
  • Skin / Extremities
    • Full equal pulses, pink nailbeds, (-) cyanosis/clubbing/edema
    • (+) multiple hyperpigmented scars on ventral side of forearm
assessment
Assessment
  • Axis I:
    • Psychosis sec. to general medical condition (seizure disorder)
    • Major depressive disorder
    • Alcohol dependence, in controlled environment
  • Axis II: deferred
  • Axis III: Seizure disorder, s/p craniotomy, evacuation of hematoma (2009)
  • Axis IV: Poor primary support; economic problems
  • Axis V: GAF 31-40
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